October 4th, 2010 by GruntDoc in Better Health Network, Health Policy, News, Opinion
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Texas is at the center of a heated national battle over the training emergency physicians need in order to advertise themselves as “board certified.” Via the Houston Chronicle:
At stake is the welfare of patients requiring immediate medical attention. Leaders of the traditional board say allowing physicians without proper training to advertise themselves as board-certified would mislead the public. Leaders of the alternative board say the proposed rule change will undermine the ability of Texas’ rural hospitals to staff their emergency departments with board-certified ER physicians.
A final verdict may only come, given one board’s already delivered threat, in a court of law.
At stake also are the careers of a lot of practicing Emergency Physicians, many of whom I’m proud to call friends and colleagues. (And it’s not just docs at rural hospitals, they’re in nearly every ED in Texas, and your lesser state). They practice high quality Emergency Medicine, and I have no qualms about the practice of those who are alternately boarded. Read more »
*This blog post was originally published at GruntDoc*
September 11th, 2009 by GruntDoc in Better Health Network, True Stories
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From an old HS buddy (also a Navy Man) now in healthcare:
Texas law makes almost any item with a doctors prescription exempt from
sales tax.
(most details at : RULE §3.284 Drugs, Medicines, Medical Equipment, and
Devices (Tax Code §151.313) Item 11 is the sort of catch all.
What is most odd item you have been asked for a prescription for purely for
tax-free purposes?
Sellers of the Select Comfort beds, and hot tub/spa dealers are very aware
of this law. Presciption needed for bed, letter and presciption needed for
hot tub/spa.
Oddest request received at clinic where I work: one for in ground pool,
heated and deep enough for water aerobics.
While I don’t notice it on that list, food for helper animals is exempt
from sales tax.
Interesting also, repair parts for devices are exempt, but not
*improvements*. If you replace like for like wheel on a walker, it is tax
free. Replace with improved wheel-taxable.
I’ve never been asked to write a prescription for anything like that in the ED, but I’d be willing to bet my office-based colleagues have. Care to share?
*This blog post was originally published at GruntDoc*
June 29th, 2009 by EvanFalchukJD in Better Health Network, Health Policy
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Everything is McAllen, Texas.
It’s all part of our “uniquely American” approach to many issues: oversimplify the problem, so we can solve it. Ideally, on an artificially short time line.
In the case of health care reform, let’s say we get ‘er done by August 1.
When we talk about health care reform, we are really talking about dozens of different issues. Is health care reform about covering the uninsured, or about cutting costs for employers? Is it about having a publicly-funded health plan, or changing reimbursements to doctors? Is it about longer life expectancies or creating insurance cooperatives? Is it about caps on medical malpractice awards, or comparative effectiveness? Is it about healthier lifestyles, or cutting the cost of prescription drugs? Is it about cutting administrative waste, or incentives for more people to go to medical school? Is it about implementing new health care IT, or preventing insurers from making excessive profits?
It’s about all of these things, and more. And that’s the problem, if you’re an ambitious reformer. There is no simple way to get all of these things under one roof.
Well, until Atul Gawande introduced us to McAllen.
The President quickly made Dr. Gawande’s article on McAllen required reading at the White House, telling Senators this is the problem we are trying to solve. His point man on health care, Peter Orszag, has been blogging about it repeatedly. Members of Congress and the press have taken to talking about McAllen as the center of the health care debate. Even doctors from McAllen are calling on the President to come and see for himself.
Others are using it, too. Paul Krugman, in his blog, took on Harvard economist Greg Mankiw for saying that some comparisons of the US and foreign health care systems may be flawed as a premise for U.S. reform. In response Krugman said “read Atul Gawande!” I saw this, too, when I questioned Steven Pearlstein about why he had such a problem with doctors. His only response was “Maybe you should talk to Atul.”
The problems of McAllen make easy talking points. But they are also a convenient way of avoiding dealing with the enormous complexity of the health care system. There are nearly 650,000 doctors in America, millions of patients, thousands of hospitals, tens of thousands of insurance and pharmaceutical companies, hundreds of thousands of employers who provide health benefits, and thousands of other charities, academics, consultants, government agencies and others who have strongly held views about our system. Too often, their voices are not being heard in all the loud talking about McAllen.
And so, if reforming our health care system is, as the President says, a “moral imperative,” why can’t we have a process that treats reform that way? Why the rush to pass reforms that have to be sold under the premise of solving the problems of McAllen?
The President and the Congress are perfectly capable of putting together a respected commission of experts to study health care, in depth, and then return with serious, comprehensive recommendations that Congress and the President can work to enact. Polls show great public support for the idea of reform, but mixed understanding on what reform means. As we see from the evaporating support for reform in Congress, this gap is a serious problem.
We need effective health care reform in America. McAllen isn’t enough to close the deal.
*This blog post was originally published at See First Blog*
January 13th, 2009 by Dr. Val Jones in News
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This is one of the saddest stories I’ve read in a while. H/t to GruntDoc.
Dr. Michael Sanchez, who in a few months as director of University Hospital’s busy emergency department slashed waiting times and reduced the number of patients turned away because of overcrowding, was struck and killed while jogging Sunday afternoon.
His own emergency department colleagues tried to save Sanchez without recognizing him because of the extent of his injuries. Only after he was pronounced dead did they learn it was Sanchez, hospital staff said.
…
Police said Sanchez was struck in the 11600 block of Bandera Road about 1:40 p.m. Sunday. The driver told police he was on his way to get the brakes on his SUV fixed when his cell phone rang. As he answered it, he said he spotted Sanchez on the side.
According to a police report, Smith said he hit the brakes and the car swerved onto the shoulder, striking Sanchez and sending him onto the hood of the car.
A witness said the driver swerved across two lanes before striking the victim. Police said no charges have been filed.
…
Rufe said Sanchez had so much enthusiasm and energy for the job, it made some of his colleagues skeptical about him. But it was that drive that allowed him to push the department beyond the way things had traditionally been done.
“He was telling me one day, ‘I love my job. I love what I do. I love my family. We have a wonderful home. I can’t ask for anything else. And now the possibility of a residency program. I’m just a fortunate person,’” Rufe said.
